Dumirieh
Start free

Rapid Review·Cardiovascular

Select any text to highlight it or add a note.

Cardiomyopathy

T1Must know

Cardiomyopathy

Focus on

A disease of the heart muscle itself, acquired or inherited, ending in arrhythmias and heart failure. Rule out ischemia, then let the echo sort the type: dilated (systolic, eccentric), hypertrophic (diastolic, concentric), restrictive (diastolic, normal EF) or stress-induced (apical ballooning). Every type gets heart failure drugs and diuretics for congestion, plus treatment of the cause.

Key takeaways

Overview

Definition

a cardiomyopathy is a disease of the heart muscle itself, acquired or inherited.
  • It impairs the pump, leading to arrhythmias and heart failure.
Working up a cardiomyopathy: an ischemic workup, then a transthoracic echo sorts it. Dilated: larger chambers with thin walls and reduced systolic function. Hypertrophic: thick left ventricular walls, normal or small cavity, usually preserved systolic function. Restrictive: diastolic dysfunction with normal or mildly thick walls and normal or slightly reduced systolic function. Stress-induced: akinesis of the apex. All get treatment of the underlying disease and guideline-directed therapy.
What this shows
Working up a cardiomyopathy: an ischemic workup, then a transthoracic echo sorts it. Dilated: larger chambers with thin walls and reduced systolic function. Hypertrophic: thick left ventricular walls, normal or small cavity, usually preserved systolic function. Restrictive: diastolic dysfunction with normal or mildly thick walls and normal or slightly reduced systolic function. Stress-induced: akinesis of the apex. All get treatment of the underlying disease and guideline-directed therapy.

Workup

  • Ischemic workup: rule out coronary disease first.
  • Transthoracic echocardiography (TTE): sorts the type by chamber size, wall thickness and systolic function.

The Types

The three structural cardiomyopathies beside a normal heart. Hypertrophic: a thicker left ventricular wall with septal predominance. Dilated: ventricular dilation with thin walls and possible atrial dilation. Restrictive: stiff ventricles with dilated atria.
What this shows
The three structural cardiomyopathies beside a normal heart. Hypertrophic: a thicker left ventricular wall with septal predominance. Dilated: ventricular dilation with thin walls and possible atrial dilation. Restrictive: stiff ventricles with dilated atria.
The cardiomyopathies at a glance
TypeMechanismCausesFindings
Dilated (DCM)Systolic dysfunction; eccentric hypertrophy (sarcomeres in series)Idiopathic or familial (TTN gene); ischemic heart disease (most common secondary), hypertension, alcohol, myocarditis, drugs (doxorubicin, zidovudine, cocaine), peripartum, radiation, infections (coxsackievirus, HIV, Chagas), endocrine disease, wet beriberiS3, systolic regurgitant murmur; "balloon" heart on chest radiograph; dilated chambers on echo
Hypertrophic (HCM)Diastolic dysfunction; concentric hypertrophy (sarcomeres in parallel)Hypertension (most common acquired), aortic stenosis, Friedreich ataxia, hypertrophic obstructive cardiomyopathy (HOCM)S4, systolic murmur with mitral regurgitation; left ventricular hypertrophy with septal Q waves; septal hypertrophy, systolic anterior motion of the mitral valve, outflow obstruction on echo
Restrictive (RCM)Diastolic dysfunction without systolic dysfunction; normal or near-normal EFInfiltration (amyloidosis, hemochromatosis, sarcoidosis), scleroderma, Loeffler eosinophilic endocarditis, endomyocardial fibrosis, radiationRight-sided failure predominates (jugular distension, edema, ascites); low voltage or left bundle branch block; rapid early filling on echo; biopsy may show the infiltrate
Stress-induced (Takotsubo)Transient apical ballooning from catecholamine surgeMarked physical or emotional stressLooks like an infarct (chest pain, ST elevation, troponin) with normal coronaries; mid and apical hypokinesis with basal hyperkinesis

Pages

Dilated Cardiomyopathy, Hypertrophic Cardiomyopathy, Restrictive Cardiomyopathy, Takotsubo Cardiomyopathy, Peripartum Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy.

General Management

Guideline-directed medical therapy

the heart failure drugs (Heart Failure).
  • Beta blocker.
  • Angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB) or angiotensin receptor-neprilysin inhibitor (ARNI, sacubitril/valsartan).
  • Mineralocorticoid receptor antagonist.
  • Sodium-glucose cotransporter-2 (SGLT2) inhibitor.

Diuretics

for symptoms, particularly volume overload; first line in DCM.

Cause-specific treatment

chosen by the cause of the cardiomyopathy.
Echo shows thick left ventricular walls with a small cavity in one patient, and dilated chambers with a low ejection fraction in another. Which cardiomyopathy is each, and which kind of hypertrophy?

The first is hypertrophic (diastolic dysfunction, concentric hypertrophy with sarcomeres added in parallel). The second is dilated (systolic dysfunction, eccentric hypertrophy with sarcomeres added in series).

How it's tested

Echo shows dilated chambers with an ejection fraction of 25 percent: dilated cardiomyopathy; systolic dysfunction with eccentric hypertrophy.

Echo shows a thick septum, a small cavity and systolic anterior motion of the mitral valve: hypertrophic cardiomyopathy; diastolic dysfunction with concentric hypertrophy.

Right heart failure with a normal ejection fraction, bi-atrial enlargement and a low-voltage ECG: restrictive cardiomyopathy, likely amyloid.

Chest pain and ST elevation after emotional stress, clean coronaries, apical ballooning: stress-induced (Takotsubo) cardiomyopathy.

Go deeper

Related Step 2 pages: Dilated Cardiomyopathy, Hypertrophic Cardiomyopathy, Restrictive Cardiomyopathy, Takotsubo Cardiomyopathy, Peripartum Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy, Heart Failure

High-yield images2
Working up a cardiomyopathy: an ischemic workup, then a transthoracic echo sorts it. Dilated: larger chambers with thin walls and reduced systolic function. Hypertrophic: thick left ventricular walls, normal or small cavity, usually preserved systolic function. Restrictive: diastolic dysfunction with normal or mildly thick walls and normal or slightly reduced systolic function. Stress-induced: akinesis of the apex. All get treatment of the underlying disease and guideline-directed therapy.
The three structural cardiomyopathies beside a normal heart. Hypertrophic: a thicker left ventricular wall with septal predominance. Dilated: ventricular dilation with thin walls and possible atrial dilation. Restrictive: stiff ventricles with dilated atria.
PreviousCardiorenal SyndromeNextDilated Cardiomyopathy

You just read one page of 238

The rest of Step 2 CK, written exactly like this.

Rapid Review is the reading layer of a full Step 1 platform: a schedule fitted to your exam date, flashcards for every page, and a mentor a message away.

  • Every Step 1 system

    Written the same way: what to know, how it’s tested, where to go deeper.

  • A plan built to your exam date

    Tell us when you sit, and the schedule fits the whole library and your question bank to it.

  • Flashcards for every page

    Ready-made spaced-repetition decks linked to each topic, so nothing you read gets forgotten.

Start 14 days free
No card needed.·See pricing